Definition & Diagnostic Criteria

Migraine is the most common primary episodic headache disorder. It is derived from Greek word ‘Hemicrania’ which means half of the head; it means a headache which affects half of the head. However, the latest understanding on migraine is as follows:

Migraine is one of the varieties of recurrent headache which is not always a strictly unilateral headache; it can be bilateral and is characterized by various combinations of neurological, gastrointestinal and autonomic symptoms.

Signs and Symptoms:

Accurate diagnosis of any disease is important because it has specific treatment implications. However, at present, headache diagnosis is clinical; hence there are no “gold standard” tests or biologic markers that exist for the diagnosis of migraine. In the absence of any objective parameter, the most widely used headache classification system was first developed in 1988 by International Headache Society (IHS) and revised in 2004.

IHS Criteria for the diagnosis of Migraine without Aura:

  • Idiopathic, recurrent headache (> 5 attacks per year)
  • 4-72 hrs duration *
  • Pain characteristics (2/4)

    - Unilateral / Bilateral location
    - Pulsating quality
    - Moderate to severe intensity **
    - Aggravation by routine physical activity

  • During attacks (1/2)

    - Nausea and / or Vomiting
    - Photophobia and Phonophobia

  • At least one of the following

    - No secondary cause for headache
    - Secondary cause suggested but ruled out by investigation
    - Secondary cause present but migraine does not occur for the first time in close temporal to the disorder

Associated symptom among migraine patient (Source IHS):

Nausea 87%
Photophobia 82%
Light Nausea 72%
Scalp tenderness 65%
Vomiting 56%
Visual disturbances 36%
Paresthesia 33%
Vertigo 33%
Altered Consciousness 18%

Migraine has been defined as a major neurological condition among debility causing diseases by World Health Organisation. Migraine commonly starts at puberty and affects those aged between 30 – 40 years but can trouble much younger and elderly people, including children. As migraine is more troublesome at the productive years, financial cost of society, principality from lost working hours and lost productivity are incalculable. Thus migraine brings substantial health care burden both clinically and economically to the individuals and their families. However this problem worsens when migraine converts into chronic daily headache in 4% of general population and in 22% of migraine sufferers. Around 40% of chronic migraineurs develop significant disability (MIDAS score > 22)